II. Pathophysiology
- Results in wasting of body fat and Muscle
- Cytokine elevations related to Wasting Syndromes
III. Symptoms
- No appetite (Anorexia)
- Unintentional Weight Loss (Cachexia)
- Fatigue (see Fatigue in Cancer)
IV. Differential Diagnosis
- See Unintentional Weight Loss
- Chronic organ failure
- Serious chronic infection
- AIDS
V. Evaluation: Identify and treat reversible causes
- Chronic Pain
- Pancreatic exocrine enzyme insufficiency
- Diminished gastrointestinal motility
- Mouth condition
- Dry Mouth (Xerostomia)
- Dental or jaw related issues
- Chemotherapy related Oral Mucositis
- Infection
- Oral Candidiasis
- Oral Herpes Simplex infection
VI. Management: Nutrition
- Background
- Wasting is not reversed by improved nutrition
- Aggressive alimentation may increase discomfort
- Management
- Small Frequent Meals
- Avoid blended, pulverized foods
- Avoid Parenteral nutrition
- Patient eats what they want
- Avoid dietary restriction (diabetics eat ice cream)
- Avoid foods with unpleasant odor
- Educate families that wasting is not inadequate care
- Families can offer care in alternative ways
- Moisten patient's lips or mouth with sponge
- Offer massage
- Read or play soft music for patient
VII. Management: Medications
-
General
- Discontinue medication if no benefit in 2-6 weeks
- Main options
- Megestrol acetate (Megace) 200 mg PO q6-8 hours
- Dexamethasone (Decadron) 2 to 20 mg PO qAM
- Dronabinol (Marinol) 2.5 mg PO bid to tid
- Medroxyprogesterone acetate
- Experimental: Androgens
- Oxandrolone (Oxandrin)
- Nandrolone (Durabolin)
- Other options
- Macrolide Antibiotics
- Cyproheptadine
- Hydrazine sulfate
- Cannabinoids